Are you Constantly Receiving Denial Code CO-197?

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Are you Constantly Receiving Denial Code CO-197?
What is Pre Authorization? Most of the carriers
request to obtain prior authorization from them
before the service/surgery. Prior authorization
for health care services is required for certain
services. If authorization is not obtained prior
to performing the service, the insurer may not
reimburse for the procedure. Most services
requiring prior authorizations are surgical
procedures or high-cost ancillary services or may
be determined as not necessary in some
circumstances. The requirement for prior
authorizations can lead to delays in needed
healthcare, affecting both patient outcomes and
patient satisfaction. Depending on what the
patient's coverage documents and the provider's
contract with the insurer say, neglecting to
obtain preauthorization can result in reduced
reimbursements or lower benefits for the patient.
Services that don't require preauthorization can
be subject to review in some cases.   How to take
Pre Authorization? The key to a solid
preauthorization is to provide the correct CPT
code. The challenge is that you have to determine
the correct procedural code before the service
has been provided (and documented) an often
difficult task. To determine the correct code,
check with the physician to find out what she/he
anticipates doing. Make sure you get all possible
scenarios otherwise, you run the risk that a
procedure that was performed wont be covered.
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Are you Constantly Receiving Denial Code CO-197?
The method to obtain prior authorizations can
differ from payer to payer but usually is
performed by either a phone call, the submission
of an authorization form, or an online request
via the payers website. Most often, payer
portals are the preferred method of submitting
prior authorizations. The portals may allow you
to register for access, or you may have to gain
access through your facilitys administrator. To
determine whether a service requires an
authorization, you must be aware of each payers
policies, which can usually be found on the payer
Website and the payer/provider contract. Because
of the need to describe medical necessity, this
is most commonly performed by a medical assistant
or other staff who can effectively communicate to
the payer with an understanding of medical
procedures.   Missed to take Pre
Authorization? With some insurers, you can get
authorization retroactively, but with others,
retroactive authorizations aren't given, even if
failure to get it in the first place was a
mistake. Still other insurers may overturn a
denial based on lack of preauthorization if
appealed, but generally, they're not under an
obligation to make the reimbursement if the
process for preauthorization was not followed.
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Are you Constantly Receiving Denial Code CO-197?
When services are provided without expected
preauthorization, what happens next depends on
the insurer and the specific policy under which
the patient is covered. Some insurance plans
state that if a patient seeks services requiring
pre-authorization, but doesn't obtain
preauthorization, the patient is liable for
covering the payment. If a provider neglects to
obtain preauthorization and payment is denied by
the insurer, it may come down to absorbing the
cost of the treatment or trying to collect it
directly from the patient, neither of which are
good options.     In this case, the provider has
to make a decision about whether to pursue
collecting the payment from the patient. Some
swallow the loss. Others send the unpaid bill to
the patient, but doing so is bad business.
Patients are both unaware of the process and not
in any sort of position to guess what CPT code
should be submitted to the insurance company. We
at Medical Billers and Coders (MBC) take the list
of CPTs which will require Pre Authorization from
insurance companies website. Pre Authorization
makes sure timely payment from payer side. To
know more about RCM services provide by us you
can mail us at info_at_medicalbillersandcoders.com
or visit us at www.medicalbillersandcoders.com.